Abstract | OBJECTIVES: DESIGN: Economic evaluation alongside a cluster randomised, controlled trial. SETTING: 11 Dutch nursing homes. PARTICIPANTS: INTERVENTION:
Nursing home access to CRP POCT (POCT-guided care) was compared with usual care without CRP POCT (usual care). MAIN OUTCOME MEASURES: The primary outcome measure for the cost-effectiveness analysis was antibiotic prescribing at initial consultation, and the secondary outcome was full recovery at 3 weeks. ROI analyses included intervention costs, and benefits related to antibiotic prescribing. Three ROI metrics were calculated: Net Benefits, Benefit-Cost-Ratio and Return-On-Investment. RESULTS: In POCT-guided care, total costs were on average €32 higher per patient, the proportion of avoided antibiotic prescribing was higher (0.47 vs 0.18; 0.30, 95% CI 0.17 to 0.42) and the proportion of fully recovered patients statistically non-significantly lower (0.86 vs 0.91; -0.05, 95% CI -0.14 to 0.05) compared with usual care. On average, an avoided antibiotic prescription was associated with an investment of €137 in POCT-guided care compared with usual care. Sensitivity analyses showed that results were relatively robust. Taking the ROI metrics together, the probability of financial return was 0.65. CONCLUSION: POCT-guided care effectively reduces antibiotic prescribing compared with usual care without significant effects on recovery rates, but requires an investment. Future studies should take into account potential beneficial effects of POCT-guided care on costs and health outcomes related to antibiotic resistance. TRIAL REGISTRATION NUMBER: NL5054.
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Authors | Tjarda M Boere, Mohamed El Alili, Laura W van Buul, Rogier M Hopstaken, Theo J M Verheij, Cees M P M Hertogh, Maurits W van Tulder, Judith E Bosmans |
Journal | BMJ open
(BMJ Open)
Vol. 12
Issue 9
Pg. e055234
(09 15 2022)
ISSN: 2044-6055 [Electronic] England |
PMID | 36109036
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. |
Chemical References |
- Anti-Bacterial Agents
- C-Reactive Protein
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Topics |
- Anti-Bacterial Agents
(therapeutic use)
- C-Reactive Protein
- Cost-Benefit Analysis
- Humans
- Nursing Homes
- Point-of-Care Testing
- Practice Patterns, Physicians'
- Respiratory Tract Infections
(diagnosis, drug therapy)
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